The proposed project will investigate the influence of social networks on women's decisions to use skilled birth attendants (SBA) and the criteria used in these decisions. The study aims are to 1. Explore the utility of the Network Episode Model of Utilization (NEM) in explaining women's health service utilization decision-making in the context of a normal biological event and, 2. Test the predicative power of women's self identified decision-making criteria on choice of birth attendant in the event of an uncomplicated pregnancy and birth. The purpose is well aligned with the National Institute of Nursing's mission and area of research emphasis, promoting health and preventing disease. Worldwide an estimated 529,000 women die annually from pregnancy- and childbirth-related complications with a disproportionate number (99%) occurring in developing countries. Preventable and treatable conditions such as post-partum hemorrhage, sepsis, eclampsia and obstructed labor are the leading causes of maternal deaths worldwide. Use of a SBA to improve identification and management of these conditions is an effective means to reduce maternal mortality. However, SBA services remain underused even in settings where SBAs are available. To understand why women are using or not using SBAs during delivery, the study will employ the NEM to more fully test the influence of socio-structural context on decision making and deliniate the specific criteria used in decision-making through ethnographic decision tree modeling. The study will employ a retrospective, cross-sectional design. Face-to-face interviews using a structured interview instrument will be conducted with a representative sample of 254 women in Matlab, Bangladesh. This research will provide a model that can be used to investigate health care utilization decision-making in the context of prevention as well as illness response. The relevance to public health and the long term goal of the research is to reduce the high levels of maternal death and disability observed in vulnerable populations both in Bangladesh and the United States. The Healthy People 2010 Objective 16-4 and the United Nations Millennium Development Goal 5 have identified the reduction of maternal mortality as a public health priority.